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*NURS 131- Exam 3: Gastrointestinal Dysfunction
Terms in this set (80)
What are some chronic, long term GI problems?
IBD such as Crohn's and ulcerative colitis.
Short gut or short bowel syndrome.
What are some acute, short term GI problems?
The GI system's job is digestion and absorption of nutrients. It has secretory, barrier, endocrine, immunologic functions.
Dysfunction produces what?
Inflammatory and malabsorption disorders.
What is NVD?
Nausea, vomiting and diarrhea.
Why should you worry about NVD?
It causes a fluid balance disruption.
Indicator of homeostatic imbalance.
Indicator of infection.
Could even be an indicator of something worse.
What is an alteration in the frequency, consistency or ease of passing stool?
It can cause painful bowel movements and retention of stool.
Constipation can be secondary to a number of disorders such as what?
Structural disorders of the intestine.
Issues with fluid intake.
Majority of cases are idiopathic.
What is the common side effect of constipation?
So what do we do about constipation? Clinics generally deal with most cases but hospitals deal with severe cases.
In the case a patient comes to the hospital with constipation we may have to load or overload the patient with laxatives such as any of the following:
It is also important to educate the patient about fluid intake and fiber!
World wide there are estimated 1.3 billion episodes of diarrhea per year. About 24% of all deaths of children living in developing countries are related to diarrhea and dehydration.
200,000 kids are hospitalized every year for diarrhea.
In the case diarrhea lasts less than 14 days it is considered acute. How long until it is considered chronic?
If a patient has diarrhea for more than 14 days.
What are the causes of diarrhea?
Bacteria, viruses, parasites and toxins.
Most pathogens spread by fecal-oral route through contaminated what?
Food or water or person to person.
What is the treatment for diarrhea?
Assess fluid and electrolyte imbalances.
Rehydrate the patient.
Maintenance fluid therapy.
Reintroduce regular diet.
Antibiotics or antidiarrheal meds.
How do you rehydrate?
Oral hydration is the first line of defense.
75 mEq of sodium per liter.
40-50 ml over 4 hours or 5-10 ml every 5-10 minutes.
No soda, caffeine, fruit juice, gelatin or broth.
Pedialyte or other fluids similar are okay.
IV fluids if not able to rehydrate orally.
What is a rehydration recipe?
1 liter safe drinking water.
1/2 teaspoon salt.
6 teaspoons sugar.
What diet should you reintroduce if a patient has diarrhea?
BRATT diet not for kids it has little nutritional value. So simply advance the diet as tolerated.
What exactly is dehydration?
Common body fluid disturbance in infants and children. It occurs whenever the total output of fluid exceeds the total intake regardless of the cause.
Cause of dehydration is most often what?
Unknown or insipid.
What are problems with fluid loss specific to pediatrics?
Bigger body surface area.
Proportionally longer GI tract in infants.
Nasal metabolic rate.
Infantile fluid requirements.
Infant has greater Body Surface Area, allowing what?
larger quantities of fluid to be lost in insensible perspiration
Kids grow into their what?
intestines to an extent.
Inability of infants' kidneys to
concentrate or dilute urine, conserve or excrete sodium, or acidify urine on demand.
Remember, minimum urine output is what for children and infants?
2 mL/kg/hr in infants.
1 mL/kg/hr in children.
What is pyloric stenosis?
Narrowing and dysfunction of the pyloric sphincter.
Pyloric Stenosis produces an outlet obstruction and compensatory dilation, hypertrophy, and hyperperistalsis of the stomach. It develops when?
in the first 2-5 weeks of life, causing projectile nonbilious vomitinig, dehydration, metabolic alkalosis and eventually, growth failure.
Pyloric stenosis can cause what exactly?
Thickening of band of muscle reduces opening between stomach and duodenum, inflammation and edema further reduce size to complete obstruction.
With pyloric stenosis the infant will projectile vomit and this will occur when?
Usually 30-60 minutes after feeding but may not occur for several hours. The child will probably eat well.
When a child has pyloric stenosis there will often be no evidence of pain is discomfort in the child. What other manifestations will there be?
Signs and symptoms of dehydration.
Abdominal distention and visible peristaltic waves.
Palpable olive shaped lump.
As a nurse what will you do for a patient with pyloric stenosis?
May have NG tube placed.
Educate parents about pyloric stenosis by informing them about post operative feeding and what else?
Surgical incision care.
Will vomiting occur after pyloric stenosis is treated surgically?
What is one of the most frequent causes of intestinal obstruction in children from 3 months to 3 years of age?
Peak occurrence is between 5-9 months old for intussusception. It is more common in males than females.
It is more common in children with cystic fibrosis. It is most likely related to viral infections.
What is intussusception?
A condition in which part of the intestine telescopes into itself. It is associated with mesentery getting strangulated.
What is mesentery?
a fold of the peritoneum that attaches the stomach, small intestine, pancreas, spleen, and other organs to the posterior wall of the abdomen.
Intussusception consists of blood and mucous leaking into intestinal lumen from cardiovascular pressure.
The most common site of Intussusception is the ileocecal valve.
How do you diagnose intussusception?
Currant jelly stools.
Sudden acute abdominal pain.
Tender, distended abdomen.
Signs and symptoms of peritonitis for advanced cases.
How is intussusception diagnosed?
intussusception can be treated non surgically. This method is 75% successful. If the non surgical attempt is unsuccessful, surgery is required for what?
Reduction and/or resection of telescoping intestine.
What is appendicitis?
Inflammation of the appendix. It is the most common cause of emergency abdominal surgery in the Us. 1/3 of all cases involve perforated appendix. The average age of appendicitis is 10 years.
A patient who has appendicitis will show what signs and symptoms?
Right lower quadrant abdominal pain or McBurney's point.
Rigid, tender abdomen.
In a patient that has appendicitis it can be diagnosed with what?
Elevated blood count.
Can be diagnosed with ultrasound and a CT scan.
What do you do for appendicitis?
Laparoscopic or open appendectomy.
Intussusception can be treated non surgically. These methods include what?
Non surgical includes possible air or NS enema.
What is the reoccurrences ratio for Intussusception?
What is the difference in symptoms/signs between Appendicitis and other Gastro dysfunctions? What dysfunctions have the same symptoms?
What are the risk factors for Gallbladder problems?
Sickle cell anemia.
The 3 F's, Fat, Female and Forty.
Can also occur due to pregnancy hormones.
Gallbladder stones gorm in the gallbladder and then migrate to the ducts. What does biliary colic consist of?
Severe, steady pain in epigastric or right upper quadrant. May radiate to back, right scapula or shoulder.
The pain often starts after eating and may last up to 5 hours.
Nausea and vomiting can occur as well.
Cholecystitis is inflammation of the gallbladder. The inflammation can last for how long and can cause what?
It can last 12-18 hours.
It can cause anorexia, nausea and vomiting as well as fever and chills.
How do you diagnose gallbladder problems?
Serum bilirubin, CBC, amylase/lipase.
Ultrasound and Xray Scans.
What are some medications that can be taken for dissolve gallstones?
Ursodiol or Actigall.
Chenodiol or Chenix.
What is the surgery for removing the gallbladder?
Surgery called laparoscopic cholecystectomy.
What is peritonitis?
Inflammation of the peritoneum. Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.
Peritonitis can be caused by what?
Ruptured appendix or gallbladder.
Perforated ulcer or diverticulum.
Pelvic inflammatory disease.
What are some signs or symptoms of peritonitis?
Severe abdominal pain.
Dim or absent bowel sounds.
What are some complications that can occur with peritonitis?
What are some medications that are used for peritonitis?
Broad spectrum antibiotics, then tailored to causative organism.
Treatment for peritonitis consist of what?
Peritoneal lavage can be used to determine if there is free fluid.
Mechanical bowel obstructions such as...
Adhesions, tumors, etc.
Functional bowel obstructions such as...
Problems with peristalsis.
What are some signs and symptoms of bowel obstructions?
Bowel sounds initially hyperactive, later hypo active.
What is the treatment for bowel obstructions?
GI decompression with NG.
What is diverticula?
Small outpouchings of the colon that occur in rows.
Diverticula can be where? And caused by what?
Anywhere in the intestinal tract.
Can be caused by low fiber or decreased activity levels.
There can be a delay in defecation and age can effect this.
What are some signs and symptoms of Diverticular disease?
Pain, usually left sides.
Nausea and vomiting.
What are the treatments for diverticular disease?
Stool softeners- NO laxatives.
Dietary changes- increase fiber, avoid small seeds.
IBD also called irritable bowel disease. Two specific disorders are involved. Crohn's disease and ulcerative colitis. But what causes it?
Etiology is unknown.
Multi factorial etiology evidence, however, such as the following:
Inflammatory response to bacteria or viruses in GI tract.
What is ulcerative colitis?
Inflammation limited to colon and rectum. It affects mucosa and submucosa.
There are varying degrees of ulceration, leading and edema.
What do most cases of ulcerative colitis include?
Blood diarrhea and abdominal distention.
Crohn's Disease can affect any part of the GI tract but most commonly what?
The terminal ileum.
However, it affects all layers of bowel wall in a discontinuous fashion.
In Crohn's Disease most cases involve abdominal cramping and diarrhea. The incidence has what?
Risen over past 30 years.
What is involved in irritable bowel disease?
Possible resection of affected intestine.
When a patient has IBD or irritable bowel disease cancer screenings are often done why?
Crohn's has greater risk of developing carcinomas than ulcerative colitis.
What is recommended for people with IBD regarding food?
Small frequent meals or snacks rather than 3 square meals a day.
High protein and high calorie foods.
It is important to observe for signs and symptoms of dehydration in patient's with IBD or irritable bowel disease.
As well as possible ostomy care.
Hirschsprung's disease is also known as what?
Congenital aganglionic megacolon.
Hirschsprung's disease is what?
Mechanical obstruction caused by inadequate motility of part of the intestine.
This accounts for about 1/4 of all cases of neonatal obstruction.
Hirschsprung's disease is often caught later in infancy or childhood and has been associated with what other syndromes?
Hirschsprung's disease or megacolon means there is no autonomic parasympathetic innervation in portion of colon. What does this consist of?
Infant- Failure to thrive
Often ribbon-like stools, abdominal distention but thin body, poor appetite.
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